The Good Doctor
Melissa Lee Shaw
Just before dawn, Paolo Amarú's wife reached for him.
He was already awake when she slipped into his mosquitero -- his mosquito‑netting–covered mattress -- though he did not move. Her fingers were tentative, soft, as if she were trying to stir his body without awakening his mind.
He allowed her to touch him, to stroke his side, his hip, his leg. In the dark, he could pretend she loved him.
Growing bolder, her hands slid over his shoulder, down his chest, toward his groin. His body tingled deliciously, but ‑‑ he pushed her arm away.
"Sierra, my love," he said. "You know we can't."
Sierra pulled back, flopped onto the bed in a huff. "I know you can't," she retorted. "Just my luck that that ugly foot isn't your only shortcoming."
Ignoring the sting of her words, he sat up and rubbed his gritty eyes. He lit the lantern beside the bed.
"Paolo, wait," she said. He glanced back to see her lying naked, the soft light burnishing her coppery skin. The volumes of her dark hair sprawled like waves around her head. Against the hazy background of the mosquito netting, she looked dreamlike, luminous. She curled toward him and laid her chin on his leg, looked up into his eyes. "Please, my husband. Just one more child. For me."
So beautiful and compelling was she that he could not help but stroke her soft cheek with his fingertips. "You have your hands full with the... three we have." Four, he'd been about to say.
She glared at him. "You don't care how my heart breaks. A baby at my breast -- it is the only thing that will mend my heart. But you don't care at all. I should never have married such a selfish man." She rolled away from him.
He dressed quickly and picked up the lantern, stopping, as always, at the doorway to the children's room. They sprawled together like sleeping puppies. His chest twisted with love, with fear. So precious, so fragile.
* * * * *
Santa Solangia lay isolated in the tropical forests of eastern Bolivia, three days' horseback ride from the nearest village accessible by truck. It originated as a poor campesino -- rural Indian -- village whose residents worked for a cocalero with a modest coca-leaf plantation. But in the turbulent political climate of the early 1960's, the cocalero made the mistake of lending his vocal and financial support to President Paz Estenssoro. In 1965, four months after Estenssoro's vice president, General René Barrientos, seized control of the country, the cocalero disappeared during a business trip to Santa Cruz and was never heard from again. His wife waited with fading hopes for nearly a year, until a swarm of army men appeared out of the forest and destroyed every last coca plant with machetes, shovels, and fire, then vanished once more. The cocalero's wife packed up her children and moved back to Beni, where her family was from.
A village always wracked by poverty, Santa Solangia descended into despair as its inhabitants tried to remake their lives after being abandoned by their one source of income. They staked out small subsistence farms where the coca used to grow, constantly pushing back the encroaching forest.
Two young men sought their fortunes outside the village. One returned with permanent hearing loss from the beating he got when he ran afoul of a militia which had no use for campesinos. The other vanished, his fate unknown. Life in Santa Solangia was difficult, but at least it was a known quantity. Dangerous as the forest itself was, the world outside was clearly more dangerous still.
The Santa Solangians spent the next two decades getting by as best they could, farming potatoes, corn, chilies, and vegetables, and raising what few chickens they could keep from disease and the occasional forays of ocelots. But year by year, their numbers -- and their hopes -- dwindled.
Until the doctor came.
* * * * *
In the light of the newly-risen sun, the whitewashed clinic building stood straight and proud, in contrast to the ramshackle baled-thatch houses that sprawled nearby. Paolo stooped to pick up a handful of wildflowers and a cloth-wrapped bundle left in front of the bronze statuette of the Madre de Dios, just beside the clinic's door. Inside, he set his crutch against his desk and tucked the flowers in with the bunch already wilting in the clay pot atop the filing cabinet.
The doctor had left no notes on his desk; the clinic must have been quiet last night. Paolo had barely unwrapped the bundle -- tomatoes, and some ripe red chilies -- when Rosalind burst into the clinic. She half-led and half-dragged her ten-year-old son, Mateo, up to Paolo's desk. "You must help him," she pleaded. "He refuses to eat, and he soaks the mattress with his sweat at night. And when he coughs -- there is blood."
Paolo brought Mateo into one of the clinic's four hospital rooms and examined him while Rosalind looked on anxiously. The boy looked thin and listless. Jotting notes on a chart, Paolo asked Mateo, "How long has there been blood when you cough?"
Rosalind said, "It started --" but Paolo held up a hand to silence her. Looking back at Mateo, he said, "How long?"
"Two days," Mateo said.
To Rosalind, Paolo said, "You should have brought him in last night. While the doctor was still here. If it's tuberculosis, you endanger your whole family by waiting." He had the boy lie back in one of the room's two wheeled cots.
"Can't you give him something so he can come home?" Rosalind twisted her hands in the ends of her orange and yellow shawl.
"I don't know what's wrong with him, but he could be contagious. I must quarantine him until the doctor can diagnose him."
Rosalind nodded slowly. "He's a fine doctor."
"The finest. All will be well."
"Here," Rosalind said, pushing a cloth-wrapped package toward Paolo. The aroma of warm salteñas, spicy meat pies filled with chicken, peas, eggs, and potatoes, reminded Paolo he hadn't eaten breakfast. "You watch over my Mateo."
Uncomfortably, Paolo said, "He is in God's hands."
Rosalind kissed the crucifix she wore around her neck, crossed herself, and left.
The day wore on, growing hotter and muggier. A steady stream of minor complaints -- skin rashes, mysterious pains, upset stomachs -- paraded through the clinic. At mid-day, when most villagers took their siesta, Paolo was at his busiest, since that was when everyone stopped working their farms long enough to attend to their physical ailments.
During the late afternoon lull, Quizo, a gray-haired campesino, and his young wife Marca came in. At forty-seven, Quizo was one of Santa Solangia's oldest residents. Five years ago, he had buried his first wife.
Paolo smiled at the couple and gestured toward the hallway. "Shall we?"
Inside one of the hospital rooms, a newborn infant lay inside an incubator, her chest swathed in bandages, tubes running into her nose and arms.
"She's doing well," Paolo said, checking the nasal-gastric tube and the oxygen flow. Too much oxygen, the doctor had told him, could burst the capillaries in the baby's eyes and blind her. "No signs of infection, and she's gaining weight."
Marca's hands trembled. "I want to hold her. Ah, my little darling."
"It's not safe yet," Paolo said. "A few more days."
"I thought it was her lungs that made her so blue," Quizo murmured. "But the doctor, he knew right away what it was."
"It was a miracle," Marca said. "He is a miracle, gracias a dios."
"Neither of our other two had holes in their hearts," Quizo said. "Little Siza, she will always bear a scar, won't she? How can she ever grow up strong now?"
Annoyed, Paolo said, "You'd be surprised how children can adapt to hardship."
Quizo stole a glance at Paolo's club foot and stammered, "I -- I'm sorry, I didn't mean ‑‑"
Paolo said, "The doctor says Siza will be fine. And now...." He ushered them back into the front room, to the donation station.
"Such a great man, the doctor," Quizo said reverently, rolling up his sleeve and sitting down. Marca sat next to him to wait her turn, her legs bobbing anxiously.
Paolo swiped Quizo's arm with an alcohol-soaked cotton ball. "How is your farm?" he asked, trying to distract him from the needle sliding into his wiry brown arm.
Quizo shrugged. "My potatoes, they have something wrong with them. Tomas tells me I must destroy them so the disease does not spread, but how can I? If I do, there will be no food for my children."
Paolo said, "You've seen Tomas?"
Quizo's face tightened.
"Next time you see him, tell him he still owes for when the doctor sewed up his foot, last month. Tell him if he does not come within a week, the doctor will require twice as much donation. And if he does not come in willingly... the doctor will be forced to take action."
Quizo shifted uneasily. "His foot, it got infected. That's why he hasn't donated."
"If it got infected, it's because he took the bandage off and got dirt in it, which I told him not to do," Paolo said. "He owes anyway. You know it's for the good of the village, that's why the doctor started the blood bank."
"That's a shame about your potatoes."
Quizo shrugged again. "When you cannot change things, you must adapt. We will survive."
A tall, stooped man burst through the front door of the clinic. "Emergency," he said in strangely accented Spanish. "By the river, a woman -- she's badly hurt. Come, quickly!"
The man wasn't a villager, but he looked familiar. Ah, one of the doctor's men, from the estancia. Paolo withdrew the needle from Quizo's arm and levered himself to his feet, reaching for his wooden crutch and his emergency medical bag. "How far?"
"Two miles? Three? I have a horse for you -- hurry!"
"Caimano attack. Her leg, it's badly torn, maybe broken. She's lost a lot of blood."
Paolo turned to Marca. "Find Salvador. Tell him to bring his cart to the river. Run!"
Paolo crutched his way back into the clinic, toward the supply room.
"What are you doing?" the doctor's man shouted.
"Getting plasma." A delicious blast of cool air struck Paolo as he opened the refrigerator door in the storage room and retrieved two clear plastic bags filled with pale yellowish liquid.
Outside, two saddled horses stood, sides heaving, their brown necks dark with sweat. The stranger grabbed the medical bag and the crutch, boosting Paolo into the saddle so hard he nearly fell off the other side. They took off at a gallop.
At the riverbank, the doctor's man jerked his blowing, foam-flecked horse to a halt.
Paolo's horse stopped too. Head swimming, he slid to the mossy ground. His legs buckled beneath him; he had to grab the saddle to keep from falling.
"Here!" called the doctor's man from behind his horse.
Paolo's weakened knees threatened to collapse. "My crutch!"
The doctor's man appeared and thrust the crutch under his armpit. Anxiously, he said, "She fell off the raft. The caimano grabbed her. I hit it in the eye with the pole."
As he moved around the man's horse, Paolo heard the soft sobbing, a child trying to be brave. He stopped, startled.
A pale, chubby, sniffling girl of about ten huddled beside her mother's unconscious body, holding one limp hand. A coat wrapped one of the woman's legs; dark red soaked the ground beneath. The woman's hair, blonde as wheat chaff, lay plastered to her head in wet curls. Her skin looked sickly pale.
A rifle lay across the girl's lap. Her wet eyes were a grayish green, like lake water on a rainy day. She looked up and babbled at them, incomprehensibly. English?
"I gave her the rifle," the doctor's man said. "To scare off any other caimanos."
"You left a little girl alone with caimanos around?"
"She wouldn't leave her mother! The attack happened on the other side of the river. I thought she would be safe here."
The man had already tied a makeshift rope tourniquet around the woman's thigh, twisting the rope around a short stick to tighten it. Paolo loosened it gradually for a few minutes, checking for signs of increased bleeding. As he worked, the man said, "Her name is Susan Chase. The doctor sent me to escort her to his estancia ‑‑ she had a business meeting with him tomorrow. She works for some big American company, they want to talk to him about buying his local oil wells."
"I thought the doctor had a helicopter. Why didn't he just fly her to his estancia? Here, hold this." He retrieved a plasma bag from inside his shirt and handed it to the man, starting the warmed plasma running into the woman's arm. "Keep that bag elevated. Don't let the line kink."
"I don't think he wants it to be that easy for anyone to reach him. He says if her company wants to talk to him that badly, they can work for it." The man's shoulders slumped. "I was to keep her safe," he whispered.
* * * * *
By the time Paolo got the unconscious woman settled into a bed at the clinic, the sun hung low on the horizon. Salvador, whose cart and oxen had brought the woman here, glanced at the girl, Angie. She stood staring at nothing, one white hand resting on her mother's arm. Something purple and sparkling bound her honey-colored hair in a ponytail.
In a low voice, Salvador said, "What about the gringita?"
Paolo added a second IV line for full-spectrum antibiotics. Caimano bites were nasty, filled with bacteria from the rotting flesh of previous meals.
Salvador said, "Carlota butchered a chicken today. She's making a good stew." He coughed, caught Paolo's eye. "We have room. I can come for the gringita when I'm done in the fields."
Paolo said, "Hand me that blanket."
* * * * *
Angie, the gringita, sprawled in the chair by her mother's bedside, her head resting on the mattress. Asleep. Where was Salvador?
The familiar thud of a cane on the dirt road outside jarred him. The front door swung open. Paolo looked out the window. Full dark. Too late.
The doctor was here.
Paolo came out into the front room. "A new patient, Doctor Baudouin. Your man told you? Susan Chase. She was to meet with you tomorrow."
"Apparently," the doctor said, "she will meet with me sooner." He was completely bald, his skin smooth and muted brown, like unpolished wood. "Francis and I have... discussed his failure."
"Rosalind's son Mateo is here too, he's sick. The gringa -- she's unconscious. I've prepped her for surgery."
"Is she stable?"
"I think so."
"You think so," the doctor admonished. "Have I taught you so little that you can't tell if a patient is stable?"
Paolo took a deep, invisible breath. "She is stable." He hesitated. "Her daughter is with her."
"Francis didn't mention the daughter?"
With a wolfish smile, the doctor said, "Perhaps he did not have the opportunity. Our... conversation was quite brief."
Salvador pushed through the front door. "Don Baudouin," he said, lowering his eyes.
The doctor looked back and forth between Salvador and Paolo. "Where is this daughter?"
"I can take her with me," Salvador blurted. "She won't trouble you." He made for the woman's hospital room, but the doctor held out his cane, blocking Salvador's way.
With a smile, the doctor said, "What's the rush?" He pushed open the door. Angie didn't stir. "She looks exhausted, poor thing. It would be cruel to wake her."
"As you say," Salvador said, twisting his hands in front of him. "And yet, she must be hungry. She hasn't eaten for many hours."
The doctor considered. "All right. But give her only boiled water to drink, and well-cooked food. These little gringitas -- they are not so hardy as Bolivian children."
Salvador squeezed past the doctor and gently laid a hand on Angie's shoulder. He spoke to her soothingly, but she pulled back, disoriented and alarmed. She said something. Salvador smiled and raised his hands to show he didn't understand.
The doctor spoke up. English. Angie turned to him, teary with relief. They babbled at each other. With a final fearful glance at her mother, the girl allowed Salvador to shepherd her out of the room. The doctor's implacable eyes followed her out.
Paolo said, "The woman, she works for a big company. Should something happen to either of them...."
"Something already has happened to them. Bolivia has happened to them. Come, assist me."
* * * * *
As always, Paolo was amazed at the doctor's speed and skill in surgery. His fingers flew like dragonfly wings, always sure of themselves, always right. When Paolo grew too tired to assist, the doctor sent him to a bed in the clinic's one unoccupied room. He awoke to find the doctor standing over him, shaking pills out of dark brown bottles. "Take these," the doctor said.
"What are they for?" Paolo asked. He squinted at the bottles. Isoniazid, Pyridoxine.
"Mateo has tuberculosis. You've been exposed. These will prevent you from catching it too."
"How is he?" Paolo asked.
"He'll be all right," the doctor said. "We must keep him quarantined here for a while. No visits from anyone, including his mother. And it's vital that you find out who he caught it from. Otherwise, the whole village could become infected. It'll likely be an adult; children rarely catch it from each other."
"Then why quarantine him?"
The doctor frowned. "Are you questioning my wisdom?"
"No, no, I'm sorry. I just want to understand."
"We're quarantining Mateo because it's vital to isolate all potential causes of a full‑blown TB outbreak. I've left drugs on your desk for you to send home for his whole family."
Paolo yawned. "The gringa, she will be all right?"
"We'll see. Not everyone recovers from a caimano attack." The doctor laughed at Paolo's expression.
The doctor interrupted. "How is your wife, Paolo?"
After a beat, Paolo said, "She is well."
"And your three children?"
Paolo had to take a breath to steady himself. "They are also well."
"Your boy Niklas, he is what, eight now?"
Not trusting his voice, Paolo nodded.
"A lovely age, eight. Still a child, but showing hints of the man he will become. Full of promise. A beautiful age."
Paolo's vision went white-hot, like the noon sun in the dead of muggy summer. He could barely breathe.
"Don't forget yourself, hijo," the doctor said softly.
Hijo. Son. Paolo's face burned at the implicit collusion.
The doctor picked up the chart at the foot of the bed and flipped it open. "Speak to Salvador tomorrow. The garden needs tending. You may go, Paolo."
* * * * *
Trees rose tall in the brick-walled garden behind the clinic: bushy, glossy-leafed mahogany; aromatic, evergreen cedar. Up above, a thick canopy of leaves and needles rustled and swayed, casting a muted green light on the flowers below, even in the bright early morning sun.
The trees' rough bark was nearly invisible behind the gnarled gray-green roots of the hundreds of orchids that clung to them. A riot of colors -- deep crimson, waxy white, delicate butter-yellow, cream-streaked purple -- burst in clusters around each trunk.
Paolo pulled at the vines that crawled up the tree trunks and threatened to displace the orchids. He could have asked Salvador to take care of it, but working outdoors would do him good.
It was a peaceful place, the garden -- thirty feet on a side, fenced in on three sides by a tall brick wall, on the fourth by the clinic. The gas generator shed stood against the clinic wall.
Paolo remembered walking here with Gustavo, no more than a year ago. The boy had been fascinated by the brilliantly colored blooms sprouting from the tree trunks, like a cavalcade of sleeping butterflies.
Gustavo, his little man, his firstborn son. Only a few months ago, against Paolo's wishes, Sierra had brought ten-year-old Gustavo to the clinic one night with a terrible, itchy rash. Paolo had told her they should wait; she had retorted that it was easy for him to say, since he didn't spend his whole day listening to Gustavo whine and cry. She had been certain that somehow, the children of the doctor's own assistant would be immune to... to death.
The doctor had kept Gustavo there overnight. The next morning, the boy had come home pale and moody. A week later, he vanished in the middle of the night. They never even found his body. Wild dogs, the villagers said, nodding sadly. It had happened before.
It was then that Paolo started sleeping apart from Sierra, in a separate mosquitero. She thought he was just angry, but there was another reason: he could not bear to bring another child into this world, knowing what might happen. Each child was another shackle around his heart, another hand silencing his mouth.
Paolo dug fertilizer -- the doctor's special, hand-mixed combination of ash, blood meal, and well-rotted compost -- into the dirt around the tree roots. The dusty, fertile smell overpowered the orchids' faint sweet fragrance. These particular orchids, cultivated for generations by the doctor's family, were parasites. It was important, the doctor had told him, to replenish the nutrients that the orchids sipped from the trees. There was no reason both trees and orchids could not thrive.
Paolo glanced over at the squat brick building a short distance away from the gardening shed that abutted the clinic's rear wall. The furnace building. The doctor always insisted that Salvador keep the woodpile outside it well stocked. Every now and then, the doctor would vanish inside and smoke would pour from the chimney for many hours. A small burlap sack would appear outside the furnace building's door, for Salvador to mix with the fertilizer. Not even Paolo had seen the inside of the furnace building; the doctor had the only key. He used to be curious about the building. Now, like the other villagers, he avoided it.
While he was washing his hands in a cool stream of water from the pump next to the gardening shed, he heard Salvador's voice out front. "Paolo! Paolo, where are you?"
Paolo knocked gravel off his sandals and limped back through the clinic. Salvador stood at the front desk, carrying the gringita -- Angie -- in his arms. She looked exhausted, her eyes sunken. Out of habit, Paolo glanced at the sky outside. Late morning.
"She can't keep anything down," Salvador said. "Not since she woke up."
"This way," Paolo said, gesturing for Salvador to lay her down on the bed beside her mother's. "What has she eaten?"
"Fried chuño and onions. Boiled water, as you said."
Chuño -- a dehydrated potato dish, relatively bland. "You're sure that's all?"
The girl began retching. Paolo handed her a kidney-shaped metal pan and ushered Salvador out of the room.
Sharply, Paolo said, "If I'm to treat her, I must know everything."
Salvador wouldn't meet Paolo's eyes. "Carlota -- she gave her runny eggs for breakfast."
"How old were the eggs?"
"Who can say? The kitchen is a woman's place." Salvador looked troubled, restless. "I must go, Carlota needs me."
* * * * *
"I think maybe it's food poisoning," Paolo told the doctor when he arrived that evening. "She is very ill, drifting in and out of consciousness. Fever, vomiting, diarrhea with a little blood. And she's in a great deal of pain. I started IV fluids as soon as she came in."
Without a word, Dr. Baudouin strode past him and into Angie's room. He hooked his cane on the railing at the foot of her bed. "Hm," he said thoughtfully. He laid his hand on her damp forehead, then sniffed his fingers. He touched her bluish lips and pressed gently on her abdomen. When he lifted her arm, she moaned and pulled back.
"Dengue fever," the doctor said. "She must have contracted it in La Paz; there's a small outbreak there now. There's no cure. You did well to start her on IV fluids. They are her best hope."
It wasn't food poisoning. Carlota hadn't hurt the girl. "Will she be all right?"
"Difficult to say."
"What can we do for her?"
The doctor looked at him in amusement. "You can do nothing but go home. She's in my hands now."
* * * * *
Usually, when Paolo walked in the door, his youngest, Rosa, flung herself on him, shrieking and giggling. Sierra always rolled her eyes and told him not to indulge her so, or she would grow up spoiled. Tonight, however, all three of his children sat quietly at the kitchen table, looking glum. Sierra sat in the corner sewing cream-colored lace onto a blue woolen dress. She didn't look up when he came in.
"Why the sad faces?" Paolo asked. "Has something happened?"
Rosa turned mournful brown eyes up at him. "Papa -- I miss Gustavo."
A flash of pain coursed through Paolo. He lowered himself into a chair.
"Me too," said Niklas, the middle child. "Girls don't know how to wrestle."
Paolo said, "Rosa, come here." Rosa glanced at her mother, then went to him. He lifted her into his lap. Five years old, she seemed nearly weightless. "I miss Gustavo too. We all do."
Rosa pressed her cheek to his neck. "Can we have another brother? Please?"
"Rosa, look at me."
She looked up at him uneasily.
"What did your mother say she would give you if you asked me for another brother?"
Martina, the eldest, said, "Papa, we --"
Paolo said, "Keep quiet. I'm speaking to your sister. No, Rosa, don't look at your mother. Answer the question."
Sierra didn't look up, but her hands stopped moving.
Rosa said, "Nothing, papa."
"What is this nothing much?" Rosa twisted on his lap like a bored puppy, but he held her in place. He let his voice become a little harder. "Rosa. Tell me or I will spank you."
In a small voice, she said, "She said she would make sugared tawa-tawas. But only if you said yes."
Paolo kissed the top of Rosa's head and set her on the ground. "Children, go into your room. I need to speak with your mother."
They filed out reluctantly, glancing at Sierra, who lifted her chin high.
Paolo said, "How cruel you are, to use our children like this."
"Cruel? You think you know cruelty? Try being a woman whose husband finds her so ugly he will not touch her! You're probably out screwing some younger woman who's still impressed that you're the doctor's assistant. Or -- or maybe that new gringa is prettier than I am."
She's heard of the gringa already, Paolo thought. News travels fast.
"Paolo, living like this, it is killing me! It has been four months since Gustavo... since we lost him. Until there's a new baby, we will all be stuck in this grief! The children, they need a bigger family. They're so young, and life is so uncertain! How can you want any of them to be alone in the world when we are gone?"
He said, "We've been over and over this. There will be no more children in this house. That is final."
She set her sewing aside. Her eyes acquired a dangerous gleam. "Is it, Paolo? Perhaps I should go out and take a lover too -- a handsome man, with a strong body. Since you don't care about your family, it won't bother you if my new baby's eyes are like some other man's!"
He recoiled as if slapped. For all that he was the most powerful man in the village -- after the doctor, of course -- inside, he still felt like the crippled boy who hobbled along on a crutch while the other children ran and leaped and tumbled. And yet -- how he loved Sierra, even in her rage, her lovely hazel eyes flashing, her coiled black hair coming out of its bun and framing her face.
"You don't know," he managed to choke out. "You don't know how much I care about our family, about you."
"Then show me!" she said. "Give me what I need!"
He slumped back in his chair. "I'm hungry."
"I suppose you expect me to feed you, like a servant!" She stormed out of the house, into the street.
"No," he said to the empty room, suddenly exhausted. "Like a wife."
* * * * *
When Paolo limped into the clinic before dawn the next day, he didn't immediately see the doctor. He unwrapped the packages he'd found by the little shrine outside the door -- seared corn on the cob, and fresh potatoes and onions. He went to check on the gringas, easing back the door to their room.
The doctor stood beside the unconscious girl's bed, pressing the inside of her wrist to his mouth. Dread seeped through Paolo, like rainwater through a leaky roof. The doctor looked up at him without releasing the small pale arm, his eyes mocking.
A movement caught Paolo's eye. The sleeping gringa stirred, blinked heavily. Her eyes fixed briefly on the doctor's back.
The doctor glanced over at the woman. A few moments later, he laid the girl's hand down on the bed. He licked his lips, then laughed at Paolo's alarm. "She's been in and out of consciousness all day," he said. "I'm sure she's had some very strange dreams."
Looking at the floor, Paolo said, "Doctor, is -- is dengue fever contagious?"
"Not unless you're a mosquito, no. Why?"
"I just wondered if we should move the gringita to another room. Isolate her, like Mateo."
"It's not necessary."
"Well, perhaps we should move her anyway...."
"And why would that be?"
Paolo's eyes flicked to the mother.
The doctor chuckled. "Fine, move the girl. It's all the same to me. But first -- come with me." He led Paolo into the hallway and closed the door. "Did you know, Paolo, that I received a phone call from the United States today, on my cellular phone? A Chicago hospital. They've offered me a position there, supervising physician of the night shift. And do you know what's even more remarkable? The gentleman I spoke with explained that he understands my... situation, and promised to make certain accommodations for my special needs. That's how he put it, my 'special needs.'"
A deep, primal fear tightened Paolo's windpipe. "You're not thinking of going, are you?" His voice sounded high, tinny.
"Perhaps it's time I move on, eh, hijo? To someplace that appreciates me and my unique gifts. Someplace more accommodating."
"But -- but we need you here!"
"Yes," the doctor said. "You do."
Paolo's skin prickled. After twenty years, he knew when the doctor was about to do something unpleasant.
"Sometimes, Paolo, a doctor is forced to make difficult decisions. Sometimes he must choose where to invest his time and medicines. It is not always possible to save everyone. If you were a doctor, and you were faced with the choice between these two children -- Mateo and Angie -- which would you save?"
Paolo said, "I would try to save them both."
"But if you couldn't. If they were both badly injured and you had to choose which to attend to, knowing the other would die -- which would you choose?"
"I don't know, I suppose it would depend on the nature of their injuries and which seemed to have the better chance --"
Paolo took a breath. He was so tired. "I don't know."
"You do. Which would you choose?"
"There would be repercussions either way," Paolo said. "If the gringita died, her rich mother might bring the government in to investigate. There could be a lot of trouble, for you -- for all of us. I know you wouldn't want that."
"If Mateo died -- well, his family might resent that a stranger lived at the expense of one of their own. There could be unrest. Either way, there would be a risk."
"So which would you save?"
"I would... I would save the gringita," Paolo said, then stumbled away.
* * * * *
As the sun climbed and the day heated, a tentative call came from the back. Señora Chase was finally awake.
Paolo hastened to her room to introduce himself and explain what had happened. His stomach twisted when he had to tell her that her little girl was at the clinic too, with dengue fever. Her response shocked him.
With a scowl, she said, "Kids. One damned thing after another. I knew bringing her along was a mistake." Her Spanish was heavily accented.
Paolo struggled to keep his composure. "Then why did you?"
She looked him square in the eye. "Because it's Señorita Chase, not Señora. There was no one else to look after her. And you can call me Susan, by the way." Gruffly, she said, "Can I see her?"
He fetched both wheelchair and crutches from the back room. "Later today, you can try moving around a little with the crutches. It's important for your recovery to keep the blood moving in your legs."
He helped her into the wheelchair, hanging her IV bags on its tall metal pole. Her face tightened when her bandaged leg bumped the footrest, but she didn't complain.
Angie was asleep but looking better, though the doctor had told him to watch the girl's breathing; she was still getting a lot of morphine to combat the bone‑breaking pain in her limbs caused by the dengue fever.
"It seems the doctor has worked another of his miracles," Paolo said.
"She looks awful," Susan said.
"You should have seen her when she arrived. Trust me, she looks better. She is lucky -- many children don't survive dengue fever." Paolo kicked himself as soon as the words were out of his mouth.
"Just figures," she said. "I'm here to do business, and she's got to go and get sick. They're such a nuisance, kids. You have kids?"
Nuisance, he thought, appalled. As if any of his children could be a nuisance. As if Gustavo had been a nuisance. "I have... three children, yes. They are -- they are my heart."
Susan was staring at a dark spot on Angie's wrist. A tiny scab. "What's that?"
"It's nothing," Paolo said hastily. "I tried to start an IV there. I could not find a vein." He started wheeling her back to her own room.
Susan frowned. "I thought I saw -- never mind. This damned leg, it's making me jumpy. Listen, you have a washcloth and some water?"
* * * * *
At lunchtime, Sierra showed up at the clinic with Rosalind, Carlota, Marca, and Ines, all clad in their finest dresses and carrying woven baskets. Appetizing smells wafted forth.
"What's this?" Paolo said, his heart leaping.
Sierra smiled, though her face was hard, like a doll's. "We heard our guest is awake. We wanted to show her Santa Solangia's friendly side, not just her dangers. So we brought her food."
Carlota looked back and forth between Paolo and Sierra. "We brought some for you too, of course, Paolo," she said.
"It's a kind thought," Paolo said, rising. "Let me check on her and see if she's ready for company."
At first, Susan was taken aback by the idea of visitors, but Paolo assured her the village women only wanted to welcome her. He promised not to let them stay too long.
In the hallway, Paolo warned the women, "She cannot eat much. Don't try to stuff her. I know how you can be."
"Oh, Paolo," Sierra said, brushing past him. "You fuss like a hen."
Susan tried to sample each dish, but she kept exclaiming at how spicy everything was. She picked at the rice that wasn't covered with salsa cruda, and she seemed to like the chuño phuti, a side dish made of dehydrated potato, onion, and eggs. Sierra saved her dish for last, triumphantly announcing, "Today, we have beef!" But the Ají de Lengua -- thin slices of cow tongue in a heavy, spicy sauce -- made Susan blanch. Ignoring the venomous look Sierra shot at him, Paolo suggested that perhaps Susan had eaten enough for her first meal in two days.
"So tell me about this Dr. Baudouin," Susan said. "Where's he from?"
Paolo said, "Somewhere in Europe. I think Belgium, perhaps."
"And what brought him to Santa Solangia? No offense, but this place isn't exactly a hub of commerce. My cell phone hasn't gotten reception since I left La Paz. What's a European doctor doing here?"
"Some people prefer not to live in a hub of commerce," Sierra said. "Bolivia is a beautiful country, and the dollars earned elsewhere go far here. Perhaps he prefers a simpler life."
"It's an unusual clinic, yes? For this part of Bolivia?"
"For anywhere," Sierra said proudly. "Our Dr. Baudouin is one of the finest doctors in the world."
"I'm sure he is. Has he lived here long?"
"Oh, about twenty years."
Susan turned to Paolo. "And you've worked for him that whole time?"
Paolo nodded. "When I was fifteen, my father went to him with a bad pain in his chest. He was so impressed with the doctor's treatment that he offered to have me work at the clinic. I've been assisting the doctor ever since."
"You can't imagine what it was like before he came," said Ines, the oldest woman there, with her long gray braids and her leathery, lined face and neck. "After our cocalero left us, there was so little food, so much sickness. So many of the children died, before they even learned to walk."
"You mean you didn't have a doctor before Dr. Baudouin?" Susan asked.
"We had a curandero," Ines said. "Don Yupanqui. He used to travel around all the nearby villages."
At Susan's baffled look, Paolo explained, "A healer. He knew a lot of local remedies and treatments. The villages are far apart, so traveling between them takes a lot of time. We only see people from other villages once or twice a year."
"What did he think of Dr. Baudouin?"
"It's a funny thing," Ines said. "Don Yupanqui left a few weeks before Dr. Baudouin arrived, and we never saw him again. Dr. Baudouin came here to settle down and run his estancia, his cattle ranch. He had retired from medicine. But when we found out he was a doctor ‑‑ well, little by little, we started going to him for help. And eventually he converted our old schoolhouse into the clinic. It was falling apart. His servants had to rebuild it from the ground up."
"What happened to Don Yupa -- Yupak --"
"Don Yupanqui." Ines shrugged. "Who can say? He was always on the move. The forests are dangerous." She nodded toward Susan's bandaged leg. "He may have been lost to a caimano attack. Or something else. He kept to himself, Don Yupanqui. Always traveled alone."
"You're lucky Dr. Baudouin showed up when he did. He sounds like a generous man."
"He is a holy man," Ines said reverently. The women crossed themselves.
Rosalind said, "That's what some say."
Sierra glared at Rosalind. "He is a very busy man."
"He is a very strange man," Rosalind retorted.
"Rosalind," Carlota hissed.
"Did you have mosquito netting for your mattress before the doctor arrived?" Sierra said. "Did you even have a mattress? He gives us clothing, and medicines, and he asks for almost nothing in return. He even gives us beef from his own herd, many times each year!"
Rosalind ignored her. "He never visits with us. Never even comes out when the sun is in the sky. And who here has ever been to his estancia? Not even Paolo, I'd bet."
All eyes turned to Paolo.
"I've been there," Paolo said uncomfortably. "It is very grand. He has many servants and a large herd of cattle. Very healthy." He managed a wan smile.
"How else is he strange?" Susan asked. Paolo realized that she had been guiding the conversation in this direction. The back of his neck began to sweat.
Rosalind crossed herself. "You have only to look at him," she said in a low voice. "He is not a normal man."
To Susan, Paolo said, "You must forgive Rosalind. Her son Mateo is sick, and she worries for him."
"The doctor is a great man, a saint," Ines said to Rosalind hotly. "You think you have it hard now? Five of your children are alive. I bore eleven. Eleven babies. Do you know how many survived their first year? Two. That's what it was like after Don Arnulfo disappeared, before the doctor came. Eighteen horrible years. You were just a little girl when he came, you don't remember."
"Such dark talk," Paolo said, smiling, trying to ease the tension. He stood, motioned to the village women. "We have kept Susan awake long enough. She needs her rest."
* * * * *
Sierra was waiting up when Paolo got home, sitting at the table, hands folded in her lap. She looked chastened.
"How was the clinic today?" she asked as Paolo leaned his crutch on the wall next to the door.
He sat at the table; she got up and brought him a plate filled with fragrant fried potatoes, eggs, onions, peppers, tomatoes, rice, and chuño, then dipped each of them a cup of chicha, a fermented corn drink, from the big clay pot beside the table. He stirred the food around, wondering what was going on. "The clinic was fine," he said. "Mateo's cough is better. The gringita seems stable, and Susan was able to walk a little on her crutches."
Breathlessly, Sierra said, "Paolo -- I -- I'm sorry. About the other night. I get so crazy sometimes, when my heart burns for something."
Paolo started eating, wondering if she had poisoned his food; this contrition was unlike her. But it only tasted a little salty. He sipped his chicha. Mashed corn kernels swirled around his tongue.
"Ah, you don't believe me. I don't blame you." She sat close to him. "I know I can be headstrong. I think I forget sometimes how lucky I am to have married you, how well you provide for us. The other women, they're jealous that I have nicer clothes, that we always get the first cut from the doctor's cows. You never beat me, you're kind to the children.... I don't know what I'd do without you." Her eyes glistened. She lowered her head, sipped her chicha.
His throat hurt. He drained his cup; she refilled it.
"I remember when we were children," she said. "How the other children mocked you. But I never did."
Of course you did, he thought. You were the worst, the loudest. How can you have forgotten? But he didn't want to break the spell of this moment.
"You were quiet, but you were so smart, even then! If the doctor's coming was a blessing for everyone, it was doubly a blessing for you. He let you exercise your mind, gave you the means to make something of yourself." She ran a finger along the rim of her cup. "Ah, Paolo. I remember when you first started courting me. My father was opposed, did you know? He thought our children would be crippled, like you. But I could see what the future would bring. I could see that when the doctor grew old, you could become the doctor in his place. I knew if my children ever had a chance of escaping this constricted life of ours, it was through education, reading, learning. Through you. And -- " she lowered her head and blushed -- "you were gentle. Respectful. Not full of boasts and bluster like some young bull."
He kept eating, though the food tasted like dust. These words -- he had waited forever for words like these.
She sighed. "I've been unfair to you, I know it. I talked with Carlota today, I was complaining, like I always do. You know what she said to me? She said, 'Sierra, you selfish cow. You're the only woman here whose fingers aren't chapped and twisted with farm work. You're the luckiest woman in all of Santa Solangia, and you know it. Stop pestering your husband. You may not understand him, but he knows best.' Can you believe that she spoke to me like that? I almost slapped her. But then I started thinking, and I realized she was right. You've always taken good care of us. I know you always will."
He sat back, watching her. He was accustomed to her fire, and he had seen her be tender with the children, but never before with him. Not like this.
"I have not been much of a wife," she said sadly.
"My dove, you are a loving mother," he said, his voice rough. He drank some more chicha. "If you're headstrong -- well, I knew that when I married you. You have a fire inside you. And you're still the most beautiful woman I've ever seen."
Her face softened. "More beautiful than the gringa?"
He chuckled. "The gringa is an ugly old boar."
They talked on through the evening, drinking chicha and laughing. When Paolo finally stood up to go to bed, he nearly toppled over. He hadn't realized how drunk he was. Sierra took his hand and led him to his mosquitero, then started undressing him.
"Sierra, no --" he said, batting at her with hands that felt very far away.
She laughed and pushed him flat onto the low mattress. "Silly man! I'm only helping you. You're too drunk."
He let her wrestle with his pants, his shirt, till he finally lay naked on the bed, which seemed to tilt from side to side, like a boat on a lake.
She took off her dress and curled up beside him, skin to skin. "Paolo, I've been thinking," she said. "I've been unfair to you in more than one way."
The feel of her skin was intoxicating. He knew he should send her away, but he was so hungry for her touch.
"You don't want more children, I understand that. But -- a man has needs. I've been too angry to take care of those needs. But now --" she rolled onto her stomach, her breasts hanging heavy, a mischievous twinkle in her eye -- "let me apologize."
It took a moment for him to realize her fingers were wrapped around his thickening member. "Wha -- stop it! You know --"
"Shhh," she said. "Cara mia, trust me. There are ways to take care of a man's needs without risking a baby. Women know of these things."
He wanted to ask how, but his mind went hot and blank as she gripped him, stroked him.
"There, you like that?" she said teasingly. He looked down at her, a hazy vision of perfection.
And was shocked as, smiling, she bent her head toward his groin.
Just the idea sent his blood soaring through his body. "It's wrong!"
"It's only a wife giving her husband pleasure," she said, her lips teasing his sensitive skin. He groaned, all thought lost.
He lay back, eyes closed, caught up in the dizzying sensations. He had never felt anything like this before. His body quickened, pushed with blinding speed toward climax.
Her mouth vanished for a moment, replaced by her hand. A new weight settled by his hips, shifting the bed beneath him. He felt her legs beside his.
He opened his eyes just in time to see her lower her groin toward his, a maddened look of triumph on her face.
Rage enveloped him. He seized her shoulders and threw her bodily off the mattress. She hit the dirt floor with a thud. "Bitch!" he screamed. His eyes burned. "How could you!"
She stood up, naked, rubbing her shoulder. "I should have waited till you passed out," she said coldly, and stalked out of the room.
* * * * *
When Paolo hobbled into the clinic before dawn the next morning, Angie was dead.
She lay on the bed, covered with a white sheet, all the tubes disconnected from her arms.
"But --" Paolo said, staring stupidly at the doctor, who watched him from the doorway. His head ached and spun from last night's indulgence. "But she was getting better!"
"She took a turn for the worse," the doctor said. "There was nothing I could do."
Paolo's throat hurt. "Does her mother know?"
"Not yet. She's still asleep in the other room."
Stunned, Paolo sank into a chair beside the cot. He lifted the sheet near the little hand.
And saw the dark spot on the inside of her wrist. A small, fresh scab, in the middle of a pale bruise. Reaching up, he pulled the sheet down from her bloodless face. He raised his eyes to the doctor's in mute accusation.
The doctor smiled. "Think what you like," he said. "It doesn't trouble me."
Paolo licked his lips. "Did -- did you --"
"Did I what?" The doctor's smile was cruel now.
"I thought you were trying to save her. You worked so hard."
"She was a lost cause," the doctor said.
"Because of the dengue?"
The doctor laughed. "My, hijo, how bold you've become. Such concern for a stranger's child." He went into his office and picked up his coat.
Following the doctor, Paolo said, "Why here? You never do it here."
Doctor Baudouin raised an eyebrow at him and sat down at his desk. "I remember once, early on, I found I missed fine chocolate. In Belgium, we had such chocolate as you could not imagine. So I found a chubby boy on the streets. For three days, I fed him nothing but candies. By the last day, he smelled like cocoa when he slept." With a fond smile, the doctor said, "After all that work, when I drained him, he had only the faintest taste of chocolate. But it was enough. A man like me -- a man of cultured tastes -- I grow tired of the same restricted diet. A new flavor can prove irresistible."
Paolo stared at him. He couldn't find words.
"I heard from Chicago again today," the doctor said. "They are most persistent. Imagine all the new flavors in Chicago. An intoxicating thought."
Perhaps it would be better, Paolo thought. His chest hurt. First Gustavo, now Angie -- and here, in the clinic. Who knows what he will do next? "If you want to go," he said slowly, "to take a little vacation, perhaps I can manage the clinic here for you until you return."
The doctor's eyes burned. "If I leave," he said in a menacing hiss, "I will raze this building to the ground and salt the earth where it stood. I will destroy every bandage, every book, every drop of medicine. Siza will die in her mother's arms; Mateo will infect the whole village with tuberculosis. Your children will die. Is that what you want?"
Shocked, Paolo said, "Of course not! I only meant, if you wanted a break --"
"You disappoint me, Paolo. I thought you more loyal than to wish me gone."
"Doctor, please, of course I do not --"
"The younger generation of Santa Solangia -- they do not understand the gifts I bring here. Perhaps I am no longer as welcome as I once was."
Hating himself, Paolo said, "We need you here! Everyone knows it. We would do anything for you!"
"So you say now, but what are you willing to do to back up those pretty words?"
Paolo swallowed and said, "Anything."
"Well, then," the doctor said, "You'll find a way to handle our gringa, won't you? Try to break the news to her gently." He gathered up his cane and left.
* * * * *
It could not have been more than a minute after the doctor left that a white-faced Susan crutched her way into the room beside Paolo.
"Susan," he said miserably, "I'm so sorry, but --" He saw from her expression that she already knew.
She sank onto the chair beside Angie's cot.
Paolo hastily replaced the sheet over the girl's arm and face. "We did all we could."
She raised shocked eyes to his. He had seen that look before. He had even seen it in the mirror. Deliberately, she pulled the sheet back down, stared at Angie's unmoving face.
"He is a fine doctor," Paolo said helplessly. "You must believe me, he did his best for her --"
She laid her fingertips on the cold forehead, brushed back a lock of hair. Touched the scab on the lifeless wrist.
"It was the dengue fever. She was just too ill, she had a relapse. At least she isn't suffering...." Paolo's voice faded when he saw the thin trails of blood on Susan's arms, from where she had torn out the IV lines.
She levered herself up, leaning so hard on her crutches that her knuckles whitened. With difficulty, she said, "I heard you. Bastard, I heard it all," and hobbled out.
* * * * *
As the sun hung low on the horizon, a determined-looking Susan crutched her way through the front room and out the door, ignoring Paolo's calls, the way she had refused to acknowledge his existence all day. Two hours later, she limped back into the clinic. With a contemptuous glance at Paolo, she collapsed into a chair in the waiting room, her face tight with pain.
"What are you doing?" he asked uneasily.
"What you don't have the huevos to do," she snapped. "Telling everyone the truth."
"Susan, it is pointless. Your daughter's passing was a tragedy, but the dengue --"
"You shut your mouth, you pig," she hissed. "Don't you dare talk about my Angie. You let it happen. You knew what he was, and you left him alone with her. Thank God the other people here have come to their senses."
Paolo's breath caught. "What do you mean?"
She nodded out the open front door. "See for yourself."
Salvador, Carlota, Agustin, Ines -- most of the able-bodied men and half the women of Santa Solangia trudged toward the clinic, grimly silent. Some carried shovels or torches.
Paolo saw the looks on their faces and knew what was coming. He could hardly bear it; he was so tired already. "You have gone too far," he said. "You understand nothing."
"I understand that not everyone in Santa Solangia is the doctor's dog." She got up and hobbled outside.
Paolo, dreading what was to come, took up his own crutch and followed her.
"You see?" she said to him.
"Only too well," he said sadly. He met Salvador's eyes and felt a current of grief and guilt pass between them.
Salvador stepped up and yanked Susan's crutches from her hands.
"What --" Susan yelped, her arms windmilling for balance. She hopped on one foot.
"It cannot be permitted," Salvador explained. "You cannot interfere here."
"But -- but he's a monster!" Susan said, shocked out of her anger.
Ines said, "He is a man of God! Have you forgotten that he saved your life? You are the monster, trying to take away our only hope!" She shoved Susan, who toppled backward with a cry. A bright red blotch appeared on the bandages around her leg.
"She was my only child!" Susan shouted, then started sobbing.
The pain in Paolo's chest was so hard, so absolute, he wondered if his heart had stopped beating altogether. He was tired, so tired. But he could not rest, not yet. His village needed him.
"She's the monster!" came one strained voice. Another: "The gringa is the real monster!" The villagers moved closer, raising shovels, fists, torches.
Paolo took a deep breath, squared his shoulders. "Stop it! Leave her alone!" He used his crutch to push through the people surrounding Susan, who sat on the ground. The villagers shrank back from him. "What are you going to do, tear her limbs from her body? Murder her right here? We are Bolivians, not animals! Violence has never been our way. In the heat of this moment, killing may seem like a solution -- but don't you see that it would poison you? I cannot let you damn yourselves!"
"But -- we have to do something!" Salvador said. "She cannot be allowed to destroy what we need."
"She is a grieving mother," Paolo said. "Show some compassion." He reached down and pulled Susan to her feet, held his hand out for her crutches. Salvador reluctantly handed them over. "Come," he said to Susan. "Come inside. I will take care of you."
Turning his back on the silent crowd, he hobbled back inside the clinic, Susan in tow. He stood in the doorway, glaring out, using his eyes to dare anyone to come in after him. When no one moved, he slammed the door.
He led Susan to her hospital room, helped her lie back.
"I don't understand," Susan whispered. "He's sick, he's evil, why don't they --"
"Shh," Paolo said. "I'll take care of everything. Don't worry."
He went to the medicine cabinet. To his surprise, a small bottle stood right in front, a syringe beside it. He read the label on the bottle: Pentobarbitone sodium. The dosage instructions were simple. Staring at the needle, Paolo wondered who needed the medicine more, Susan or him.
Paolo seated himself at Susan's side, automatically swabbing the inside of her elbow, as Dr. Baudouin had taught him years ago. He was distantly surprised that his hands still obeyed him; they seemed so far away.
"What's that?" she asked, pulling back in alarm, but he kept a firm grip on her arm.
"Something for the pain." He slid the needle into her arm.
Within a minute, her body loosened, and her breath stilled. Paolo thumbed her eyes closed and drew the sheet up over her face.
* * * * *
Paolo didn't know how long he sat there before the door swung open. Belatedly, he realized he had registered the familiar thud of the doctor's cane in the hall a few moments before. He blinked hard; tears spilled down his cheeks. He wiped them away with his sleeve.
The door opened. "Well, well," came the doctor's voice.
Paolo could not speak, could not even look up at that cold, dark face. He kept his eyes fixed on his hands, twisting the corner of the sheet that covered the gringa's body.
The doctor said, "Perhaps Chicago can wait."
* * * * *
The streets were empty when Paolo slowly hobbled the familiar route home. He felt like his whole body was made of soft cotton, numb, yielding, inanimate. That he moved at all was a wonder to him.
He could feel the eyes on him, from inside the darkened doorways. It didn't matter. Nothing mattered.
Inside, Sierra sat at the table, her hair bound up with a tall Spanish tortoiseshell comb. The children's faces peered from the dim doorway to their bedroom. Little Rosa reached her chubby arms up to him.
"Go to bed," he said to them. "Now."
Sierra stood. She wore his favorite green dress, covered with a cream‑colored shawl. "Paolo," she said uncertainly.
He dropped his crutch on the floor and limped to her, reached up to pull the comb from her dark hair. Circled his arms around her, pulled her to him, pressed his face to the soft skin of her neck. Drank in her fragrance, waiting to feel something, anything.
He pulled her to his mosquitero, threw back the netting, toppled her onto the bed with him. Lifted up her skirts.
"Paolo, wait, let me get out of this dress...."
He yanked down his trousers, wrenching one of his fingers in the cloth. The pain seemed distant, inconsequential.
His hands found her breasts. His body cried out in relief when he buried himself in her.
This was all that mattered, this body pleasure, this moment of sensation -- but even this could not drown out the roaring silence in his cold, dead heart.